Tizanidine Hydrochloride interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  The sedative effect of tizanidine may be potentiated by concomitant use of other agents with central nervous system (CNS) depressant effects. In addition, tizanidine and many of these agents (e.g., alcohol, anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, muscle relaxants) also can exhibit hypotensive effects, which may be additive during coadministration and may increase the risk of symptomatic hypotension and orthostasis, particularly during initiation of therapy or dose escalation.

  What to do: Caution is advised and more gradual dose titration may be appropriate when tizanidine is used with other substances that can cause CNS depression and/or hypotension, particularly in elderly or debilitated patients. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to avoid rising abruptly from a sitting or recumbent position. Patients should contact their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or excessive CNS effects that interfere with their normal activities.

  1 source

  1. "Product Information. Zanaflex (tizanidine)." Acorda Therapeutics (2001):

Conditions

Conditions in which Tizanidine Hydrochloride needs care, as documented in this source.

• Hypotension

  Major

  Tizanidine is a centrally-acting alpha-2 adrenergic agonist with 1/10 to 1/50 the potency of clonidine in lowering blood pressure. According to the manufacturer, two-thirds of patients in a study given single 8 mg doses of tizanidine had a 20% reduction in either the diastolic or systolic blood pressure. The effect was seen one hour after dosing and peaked at 2 to 3 hours post-dose. Bradycardia, orthostatic hypotension, lightheadedness, dizziness and, rarely, syncope have occurred. Therapy with tizanidine should be administered cautiously in patients with or predisposed to hypotension. The risk of significant hypotension may be minimized by gradual dosage titration. Patients should be advised not to rise abruptly from a supine position.

  2 sources

  1. Wallace JD "Summary of combined clinical analysis of controlled clinical trials with tizanidine." Neurology 44 (11 sup (1994): s60-8;dic. 68-9
  2. "Product Information. Zanaflex (tizanidine)." Acorda Therapeutics (2001):

• Kidney Diseases

  Major

  The clearance of tizanidine has been shown to reduce by more than 50% in elderly patients with renal impairment (creatinine clearance < 25 mL/min) compared to healthy elderly patients. Prolonged pharmacologic effects of tizanidine may occur due to drug accumulation. Therapy with tizanidine should be administered cautiously and initiated at reduced dosages in patients with impaired renal function. During titration, individual doses rather than the dosing frequency should be increased.

  1 source

  1. "Product Information. Zanaflex (tizanidine)." Acorda Therapeutics (2001):

• Liver Diseases

  Major

  Tizanidine may cause hepatocellular injury. According to the manufacturer, approximately 5% of patients treated with tizanidine in clinical studies had elevations in serum transaminases greater than 3 times the upper limit of normal (or 2 times if baseline levels were elevated), compared to 0.4% in control patients. Most cases were asymptomatic and resolved rapidly following withdrawal of the drug. However, liver failure resulting in death has been reported in postmarketing use. In three cases cited by the package labeling, two involved concomitant use of hepatotoxic agents in addition to tizanidine, while the third had no other known risk factors. Because of potential hepatotoxicity, therapy with tizanidine should be administered cautiously in patients with impaired hepatic function. All patients treated with tizanidine should have liver function tests performed at baseline, 1, 3 and 6 months, and periodically thereafter. In addition, they should be instructed to immediately report any signs and symptoms of hepatic injury such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine and jaundice.

  4 sources

  1. Wallace JD "Summary of combined clinical analysis of controlled clinical trials with tizanidine." Neurology 44 (11 sup (1994): s60-8;dic. 68-9
  2. Nance PW, Bugaresti J, Shellenberger K, Sheremata W, Martinez-Arizala A "Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group." Neurology 44 (11 sup (1994): s44-51;dic. 51-2
  3. Smith C, Birnbaum G, Carter JL, Greenstein J, Lublin FD "Tizanidine treatment of spasticity caused by multiple sclerosis: results of a double-blind, placebo-controlled trial. US Tizanidine Study Group." Neurology 44 (11 sup (1994): s34-42;dic. 42-3
  4. "Product Information. Zanaflex (tizanidine)." Acorda Therapeutics (2001):

• Psychotic Disorders

  Moderate

  Formed, visual hallucinations or delusions have been reported in 3% of patients treated with tizanidine in two North American controlled clinical studies. Therapy with tizanidine should be administered cautiously in patients with a history of psychiatric disorders.

  4 sources

  1. Wallace JD "Summary of combined clinical analysis of controlled clinical trials with tizanidine." Neurology 44 (11 sup (1994): s60-8;dic. 68-9
  2. Nance PW, Bugaresti J, Shellenberger K, Sheremata W, Martinez-Arizala A "Efficacy and safety of tizanidine in the treatment of spasticity in patients with spinal cord injury. North American Tizanidine Study Group." Neurology 44 (11 sup (1994): s44-51;dic. 51-2
  3. Smith C, Birnbaum G, Carter JL, Greenstein J, Lublin FD "Tizanidine treatment of spasticity caused by multiple sclerosis: results of a double-blind, placebo-controlled trial. US Tizanidine Study Group." Neurology 44 (11 sup (1994): s34-42;dic. 42-3
  4. "Product Information. Zanaflex (tizanidine)." Acorda Therapeutics (2001):

Therapeutic duplication

Drug classes that overlap with Tizanidine Hydrochloride, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• muscle relaxants

  The recommended maximum number of medicines in the 'muscle relaxants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'muscle relaxants' category.

  Example product in the source data (US market): Orphengesic forte

• muscle relaxants

  The recommended maximum number of medicines in the 'muscle relaxants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'muscle relaxants' category.

  Example product in the source data (US market): Soma compound with codeine

• muscle relaxants

  The recommended maximum number of medicines in the 'muscle relaxants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'muscle relaxants' category.

  Example product in the source data (US market): Aspirin/methocarbamol

• muscle relaxants

  The recommended maximum number of medicines in the 'muscle relaxants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'muscle relaxants' category.

  Example product in the source data (US market): Aspirin/carisoprodol

• muscle relaxants

  The recommended maximum number of medicines in the 'muscle relaxants' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'muscle relaxants' category.

  Example product in the source data (US market): Nodolor